Heeding the Call / photographs by Chris Hildreth

heeding the call The School of Medicine Makes a Commitment to Dismantle Racism

By Bernadette Gillis / Portraits by Chris Hildreth

12 • FALL 2020

“Simply put, many minority students make the arduous effort to study, advocate for others, grieve the racial injustices of this world, mentor the next generation, and heal, simultaneously.”

– Kirsten Simmons fourth-year medical student

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say their names .

GEORGE FLOYD AHMAUD ARBERY BREONNA TAYLOR RAYSHARD BROOKS

That’s the call made by many in reference to the numerous Black people who have been killed by police or civilian vigilantes in this country. It’s a call that some say represents the long-overdue need to address systemic racism in the U.S. And it’s a call that many students, faculty, and staff say must include Duke University School of Medicine.

Spurred by the killings of George Floyd, Ahmaud Arbery, Breonna Taylor, Rayshard Brooks, and others, the School of Medicine, along with other schools across Duke and throughout the country, has made a commitment to heed the call to eliminate racism and take a stand against racial injustice.

Further driving that commitment is the COVID-19 pandemic, which has disproportionately affected racial and ethnic minority communities. Both structural racism and the pandemic have been deemed public health crises.

Beginning with the School of Medicine’s “Turning a Moment into a Movement: Dismantling Racism” event hosted in June by Dean Mary E. Klotman, BS’76, MD’80, HS’80-’85, the summer of 2020 was filled with events like Duke Health’s Walk for Solidarity (part of the national “White Coats for Black Lives” movement), panel discussions, and listening sessions with often uncomfortable but meaningful conversations that Klotman and other leaders say they plan to continue for a long time and hope will lead to change.

“We have only begun the process,” Klotman says. “It will take time to address this deep-rooted, complex problem.”

MOVING FROM A MOMENT Every year, Klotman delivers a State of the School address that typically includes highlights of the past academic year and plans for the coming one. This year, George Floyd’s death on May 25 thrust racism and racial injustice into the forefront of conversations and triggered worldwide protests. The events prompted Klotman to focus the State of the School solely on

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Dean Mary E. Klotman speaks at the Duke Health Walk for Solidarity earlier this year.

race in a virtual event that featured frank talk about the realities and challenges of racial discrimination.

“I can think of nothing more important to talk about at this moment than our need to acknowledge and to take the essential steps to dismantle any structural racism within our institution,” she said during the event. “When we do that, we can become powerful, credible champions of change outside the walls of Duke.”

The event featured a panel made up of faculty members and one student who shared their personal stories of racism and offered their thoughts on how the School of Medicine can address systemic racism and health disparities.

Even before the “Turning a Moment into a Movement” event came about, students in the medical, physical therapy, physician assistant, and graduate programs voiced their concerns and called for change. The conversations triggered by the students helped inform the content of the event.

In June, students from the Duke chapter of the Student National Medical Association (SNMA) presented the dean with a letter including a list of recommendations to bring about equity in the school. Members of the student-run organization, which focuses on supporting minority medical students, expressed disappointment in the school’s delayed response in addressing police violence and affirming support of Black students. The letter also included seven pages of student narratives, which anonymously shared their painful experiences with racism, ongoing grief, and sense of isolation at Duke.

Students described situations in which their intelli-

“...you start to ask, ‘What are some of the impediments and challenges that faculty from underrepresented racial and ethnic backgrounds experience?’”

– Kevin Thomas

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“I think what employees want is to know that everything is equitable. That comes up a lot. They feel there’s not equity across the board when it comes to a lot of things: positions, salaries, schedules.”

– Coral May

gence was questioned due to the color of their skin, or when they were subjected to racist remarks by patients that providers failed to address.

“That letter and those narratives serve as the truest reflection and mirror of where Duke as an institution rests right now,” says Kirsten Simmons, a fourth-year medical student and former SNMA co-president. “They illustrate the unique yet unfortunate challenges that minority medical students experience. Simply put, many minority students make the arduous effort to study, advocate for others, grieve the racial injustices of this world, mentor the next generation, and heal, simultaneously.”

Shortly after the June event, the school officially launched a strategic planning process with the goal of dismantling racism in the school and surrounding communities and addressing the associated inequities and injustices.

As a part of the process, the school formed four steering committees that are working to identify key issues and opportunities. Made up of two cochairs and 10 to 15 members, each committee represents one of the school’s main constituencies: health pro16 • FALL 2020

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STRATEGIC PLANS

Hundreds of faculty and staff march in the Duke Health Walk for Solidarity, part of the national “White Coats for Black Lives” movement, on June 10, 2020.

fessions students, graduate students and postdocs, faculty, and staff. There is also an oversight committee of approximately 20 representatives who will help integrate all of the committees’ findings, prioritize recommendations, and address any gaps. Dozens of other individuals within the School of Medicine have also been involved through subcommittee participation, surveys, focus groups, and interviews.

The committee cochairs and others involved in the strategic planning process are quick to point out that while they are energized and enthusiastic about coming up with ideas and recommendations, the work will take time, and there will be no overnight solutions.

“It’s not just a pen-and-paper thought exercise,” says Judy Seidenstein, the school’s associate dean and chief diversity officer. “It’s not a situation where you fill out a template and get this done by said deadline. It is personal, it is heartfelt, it is thoughtful, and it is deliberate.”

She adds that the committees are taking this opportunity to “engage all the key people whose voices have long been unheard, have been silenced, and have been on mute.”

“I think what employees want is to know that everything is equitable,” says Coral May, cochair of the Staff Steering Committee and director of the School of Medicine’s Human Resources Service Center. “That comes up a lot. They feel there’s not equity across the board when it comes to a lot of things: positions, salaries, schedules.”

“As staff members at Duke, we want our voices heard and to know that we have a say,” adds Betsy Hames, associate dean and chief human resources officer for the School of Medicine, who also serves as cochair of the Staff Steering Committee. “We’re fortunate to work at a university like Duke, where most people are really open to the ideas of others.

The time just seems right for this, while there’s a lot of momentum.”

May and Hames are hopeful that in addition to offering staff the opportunity to have their voices heard, their work will also lead to change. Their committee is focused on a number of issues, including training and recruitment. All of the committees are reviewing those issues along with a number of others, including the curriculum, mentorship, retention, promotion, representation, and diversity.

“I think there is obviously a late but better-late-than-never recognition that now,” says Judy Seidenstein.

A DEEPER DIVE INTO DIVERSITY Kevin Thomas, MD, HS’99-’07, who is cochair of the Faculty Steering Committee and assistant dean for underrepresented faculty, says the work of the four committees is a daunting task. A major part of their work is the collection and analysis of data. The committees are reviewing data from institutional surveys, focus groups, exit interviews, and testimonials captured from faculty and students to inform

“We’re fortunate to work at a university like Duke, where most people are really open to the ideas of others. The time just seems right for this, while there’s a lot of momentum,” says Betsy Hames.

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“Fostering an inclusive environment and appointing leaders who have different ideas and different life experiences will enrich the culture and elevate things that we do well.”

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recommendations for school transformation. crucial next steps. initial report summarizing acThe Faculty Steering Committee has gathered tions to date in the planning “I think there is race and ethnicity data on faculty representation, process to Duke University obviously a late but promotion, and attrition. The committee has President Vincent Price. This better-late-than-never also looked at data from previous focus groups summer, President Price rerecognition that now,” conducted in 2017 and exit interviews from quested those reports as part says Seidenstein, who racial and ethnic minority faculty who have left of the university’s sweeping has been working in the Duke since 2016. Additionally, they asked faculty commitment to anti-racism diversity and inclusion to share personal stories to help the committee and social justice. Dean Klotfield for more than 25 better understand the challenges that exist. man and committee cochairs years. “For a long time, “We’re trying to understand the data at a from the School of Medicine many of us—especially fundamental level,” says Thomas, who is also emphasize that the work is folks who are majority an associate professor of medicine. “Once you emotional and complex, and group—have had the have that background, then you start to ask, they plan to take the time privilege of swimming ‘What are some of the impediments and chalnecessary to come up with lenges that faculty from underrepresented racial in water as fish, and fish well-considered solutions for and ethnic backgrounds experience?’” don’t see the water that lasting change.

In 2018, the School of Medicine conducted they're swimming in until Kevin Thomas the Association of American Medical Colleges you take them out. AsAN IMPACT THAT LASTS (AAMC) Diversity Engagement Survey, which sumptions were that the The cochairs admit that this assessed perceptions of inclusion and engage‘water’ was the same for ment among faculty, staff, and students. The type of work isn’t new. The everyone. Now, it's time survey provides a range of insights into the inschool has made efforts to for us to reexamine.” clusivity of the environment as well as diversity advance racial equity and inclusion in years past, For this work to have a lasting impact, the across the school. from creating programs such as the Teaching for steering committees have made it a priority One concern is low diversity among faculty and Equity Fellowship to making the Cultural Deterto focus on sustainability.

Thomas says acschool leaders. Recent figures on the composiminants of Health and Health Disparities course countability of leadership is one way to make tion of School of Medicine regular-rank faculty a requirement for first- and second-year medical sure any work the School of Medicine does is reveal that currently 4.3 percent are Black/African students. But the groundswell of energy and American and 3.6 percent identify as Hispanic/ long-lasting. He says financial investment is attention sparked by the killings of Floyd, Arbery, Latino. Klotman says this low diversity speaks to critical as well.

Taylor, and other Black Americans provides an a dearth of mentors, role models, and thought “Whether it’s endowments or philanthropy impetus to build on earlier efforts and formulate leaders from these identity and specifically dedicated to issues around dismandemographic groups. “We need tling racism, equity, promoting health equity, to examine why we have not had and diversity and inclusion, unless we establish more success, examine the root the financial stream that will continue to provide cause, and then address how we long-term inputs into this, then it won’t susOversight Committee change going forward,” she says.

Twenty School of Medicine representatives to help integrate tain,” Thomas says.

Though the planning process the committee findings, prioritize recommendations, and Ultimately, the aim of the school’s efforts has just begun, the commitaddress any gaps is to create a more diverse, inclusive, and just tees have been empowered to institution for all and to better prepare current make a few decisions that the Four steering committees have been charged with guiding and future doctors and medical leaders to serve school can act upon now. One the School of Medicine’s efforts. The committees and their such decision was to pause the diverse communities. cochairs are: nomination process for Duke’s “Having clinicians who represent the perHealth Professions Graduate Students chapter of the Alpha Omega spectives of the patients that we take care of is Students Steering and Postdoc Steering Alpha Medical Honor Society critical to the mission,” says Thomas. “Having Committee Committee until an appointed committee researchers who are from different racial and Cochairs Nancy Knudsen, MD, Johnna Frierson, PhD, and can agree on how to move and Kenyon Railey, MD Laine Thomas, PhD ethnic backgrounds focused on health dispari+ 10-15 members + 10-15 members forward with an equitable seties research brings an element to our research lection process. Members of the portfolio that could be expanded with opSNMA and other students have Staff Steering Faculty Steering portunities to innovate and lead. Fostering an questioned why the society isn’t Committee Committee inclusive environment and appointing leaders Nadine Barrett, PhD, Betsy Hames, JM, and Coral May more diverse at Duke. and Kevin Thomas, MD + 10-15 members who have different ideas and different life On September 1, the School + 10-15 members experiences will enrich the culture and elevate of Medicine, along with other things that we do well.” schools at Duke, submitted an

Taking the Lead

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a seat at the table

IN HIS NEARLY NINE YEARS WORKING at Duke, Lowell Tyler says there have been countless times when he’s been the only Black person or Black man in the room. It can be a bit of a challenge, and even though it’s a situation he has gotten accustomed to, he says it’s one that can—and should—change.

“The notion that there are not talented, capable, African Americans that can excel, I don't believe that,” says Lowell, division administrator in the Department of Surgery.

“I think there are talented, capable people out there. So, when we’re not in the room, it raises the question, ‘Why is that?’”

There are no easy answers. But Tyler hopes his time serving on the Dismantling Racism Staff Steering Committee will make a difference, not just for himself but for the good of the school as a whole.

“I think we have an opportunity to make some tangible improvements that will enhance opportunities for all people and make it more equitable,” Tyler says. “And, hopefully, we’ll build not only a staff and a workforce that reflects our community, but also leadership that reflects it.”

In his current position, Lowell works with division chiefs and others in his department on budgeting, financial management, and strategic planning. He says he has noticed

that in some divisions there are no Black faculty members.

“I will say that it is something that is on the minds of the division chiefs and the department chairs,” Tyler says. “As we continue and renew our efforts, there are opportunities to meet the moment, and to make sure that our applicant pools are as diverse as possible. I think we do need to take the time to take a step back and ask, ‘Are there things that we are missing?’”

Tyler acknowledges that the work that he and his fellow committee members are doing isn’t new, but in some ways, he says, it feels different this time around. He says the conversations that are occurring at the school now around race are more upfront and widespread. “We know the conversations are important steps,” he says.

The committee members aim to be intentional about

their work and are looking closely at ways to find solutions that are long-lasting. Tyler says part of that is making sure everyone, particularly leadership, follows through on their promises.

“It isn’t something where you flip a switch and it happens,” he says. “We have to hold each other accountable. At all levels, leaders must be accountable for creating that culture of inclusivity.”

Tyler is encouraged by the attention the school’s leaders are giving to addressing inequalities and by the work that the steering committees are putting forth to make change.

“I think there is a moment for reflection and really examining what we can do better,” he says.

“Then there's a phase where we actually have to do the work. I think now we’re at a point where we need to do the work.”

“I think we have an opportunity to make some tangible improvements that will enhance opportunities for all people and make it more equitable.”

– Lowell Tyler

Lowell Tyler, MBA, is division administrator in the Department of Surgery.

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Activity Across Campus In addition to the “Turning a Moment into a Movement” event, a number of events on racial equity have been held around campus in recent months.

During the Duke Health Walk for Solidarity, Duke University President Vincent E. Price; Chancellor for Health Affairs A. Eugene Washington, MD, MPH; Dean Mary E. Klotman, BS’76, MD’80, HS’80-’85; and hundreds of Duke Health faculty and staff marched across the medical campus in support of racial justice and equality. Recently, Duke Health launched “Moments to Movement,” a collective pledge to right the injustices of systemic racism.

A number of School of Medicine departments and divisions have held their own events in support of the anti-racism movement, and many in the school participated in the national grassroots efforts called #ShutDownAcademia and #ShutDownSTEM. In mid-June, Duke University held a day-long, campus-wide virtual symposium, “Living While Black,” which addressed COVID-19 and human rights abuses and featured Black faculty, staff, and students’ personal stories of racism and discrimination. The event led the university to add racial equity sessions to its student orientation program this year.

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will you put the hat on?

A PAPER HAT MADE BY A FIVE-YEAR-OLD, especially one that doesn’t quite look like a hat at first glance, may not appear to have anything to do with racism. But for Kenyon Railey, MD, and those listening to his presentation during the Duke University School of Medicine’s “Turning a Moment into a Movement” event last June, the hat has to do with just that and more.

During his talk, Railey used a recent encounter with his youngest child and only daughter, Chloe, as an example of the importance of institutions backing up their statements on diversity with heartfelt action.

One day Chloe presented Railey with an object she had made. Railey was unsure what it was supposed to be. It’s a hat, Chloe revealed, and Railey promptly placed the oddly shaped headpiece onto his head.

After modeling it for a few minutes, he asked her whether she would like him to keep the hat in his room or hers. Chloe’s scowl revealed her disappointment, and he quickly assured her he would keep the hat right by his bed.

Railey later discovered that Chloe had thrown the hat in the trash. “Daddy, I knew you didn't want my hat when you asked if I could keep it in my room,” she said through tears. “I know you don't care about me, and you don't care about my hat. So I threw it away.”

Even though he had assured his daughter that the hat she made was the best hat he had ever seen, his actions had said otherwise. Railey says the same can be applied to the School of Medicine when it comes to diversity.

“You say you want diversity and inclusion,” Railey explained. “You say that diversity makes you better.

You've got a statement. So why is the evidence of that back on the shelf, or better yet, in the trash?

Why don’t you actually have diversity and inclusion for Black and brown people?”

Railey pointed out the low diversity among faculty members and medical school leadership at Duke. He then went on to challenge the school to do more to

recognize its problems and better align its actions with its mission.

“Part of the fix is acknowledging it,” he said.

“Every mental or behavioral health-oriented provider understands that you can’t fix a problem you don’t admit you have. So, if our goal is to change from moment to movement, then leaders, board members, chancellors, deans, chairs, chiefs, program directors, it’s your duty to acknowledge your failure and accept the reality that we can’t be innocent bystanders anymore.”

Much like the hat—which didn’t quite fit and was uncomfortable—Railey says the school must confront uncomfortable truths and take action.

“Bigotry, elitism, inequality, microaggressions, they all come from a racist tree with roots in every institution, in every department, every division, every person, including me,” Railey said.

“So after you’ve leaned into the discomfort of your failures, after you’ve reignited your faith and believed people of color without defending or deflecting, after you’ve committed to fidelity that must be the foundation of a future for all peoples— Black, brown, white, or otherwise—after all of that, when you put the hat on, then the next question that I want you to answer for the Duke School of Medicine, for the nation, and for the world and for Chloe is, ‘Will you leave it on?’”

Watch a recording of the “Turning a Moment into a Movement” event at bit.ly/3klpfKZ Kenyon Railey, MD, is medical director of the Duke Physician Assistant Program, assistant professor in family medicine and community health, and assistant professor in neurology. He has served as assistant chief diversity officer for the School of Medicine.

“So, if our goal is to change from moment to movement, then leaders, board members, chancellors, deans, chairs, chiefs, program directors, it’s your duty to acknowledge your failure and accept the reality...”

– Kenyon Railey

a heavy burden to bear FOR MOST MEDICAL STUDENTS, getting the opportunity to don a white coat is a major milestone, one that fills them with excitement to be that much closer to becoming a doctor.

Kirsten Simmons had that same excitement initially too. But as time passed, Simmons, now in her fourth year of medical school at Duke, says her white coat gradually gained new meaning. It now feels heavy and represents a burden she wishes she didn’t have to bear.

In late May, as news broke that yet another Black man had been killed by police—this time George Floyd—Simmons’s heart broke.

A plethora of feelings emerged. Anger. Fear.

Frustration. She thought about how, as a Black woman, she could become the next headline by simply jogging in her Durham neighborhood. Along with those feelings came the realization that for her and other Black medical students, the white coat is “just a safety garment.”

“Black medical students may find themselves dependent on names of institutions, connections with institutions,” she says.

“Those are the actual lifesavers. Not our selfworth, not our dignity, not our respect, and not the intangible components of our humanity. That’s not what protects us, and that’s not what helps us be in a beloved community with others around us. The fact that we’re defined

by other things was frustrating to me.” glance, and it’s never questioned.”

The experience prompted her to put her Despite these negative experiences, feelings down into words that were eventually Simmons remains optimistic about Duke’s published as an essay in Medium called, “My current efforts to eliminate racism.

White Coat Feels Heavy.”

“I think that Duke is taking advantage of Simmons says writing the essay was part this momentum,” she says. “Student groups, of her healing—not just from the sadness faculty members, and departments within the she felt for the men and women who School of Medicine are grasping onto that. suffered from racial injustice, but also from And they’re holding higher administration the microaggressions and prejudices she accountable for more than creating task herself endured as a medical student because forces, modifying policies, and creating of her skin color. initiatives. Advocates of this great cause are She recalls being mistaken by patients for expecting accountability and sustainability. other members of the My personal hope is to medical team—anycome back to this instithing other than a tution in due time, and “Advocates of medical student. She see tangible fruits of the this great cause also recalls the frustrawork we are currently tion of working with are expecting engaged in.” a white male medical

accountability and student whom patients Kirsten Simmons is a sustainability. My readily assumed to be fourth-year medical a doctor whether he student. She is also personal hope is to wore his white coat or completing a master’s come back to this not. “That is one of in theological studies at the privileges those of institution in due time, Duke Divinity School as a the non-minority race theology, medicine, and and see tangible fruits and ethnicity have,” culture fellow.

Simmons says. “Their of the work we are Medium article: roles, their leadership currently engaged in.” bit.ly/3m8YiuE is assumed by first

– Kirsten Simmons

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